tbuckley/cabot-search huggingface dataset:
Abstract 12086: Predicting Long-Term Survival After De Novo Cardioverter-Defibrillator Implantation for Primary Prevention
Authors: Chang ( Wang, Zihang Lu, Chris Simpson, Douglas S Lee, Joan E Tranmer
Journal: Circulation (2022)

Introduction: Current guidelines recommend the use of implantable cardioverter-defibrillators (ICDs) for primary prevention of arrhythmia in patients with reduced ejection fraction cardiomyopathy. Little is known about the long-term outcomes of patients with ICDs in clinical practice. Objective: To develop a risk prediction model for 10-year survival after ICD implantation for primary prevention. Methods: In this population-based registry of all ICD patients across 18 centers in Ontario, CA, 5097 patients receiving ICD implant for primary prevention from February 2007 to March 2011 were followed for up to 10 years. Patients were randomly split 2:1 into derivation and internal validation cohorts to develop and validate a prognostic model using Cox regression and predictors measured at initial ICD evaluation. Results: Mean age was 65.3 years (SD 11.0), 664 patients were female (19.5%) and 2344 patients (69.0%) had ischemic cardiomyopathy for primary disease indication. 10-year survival was 45.7% (95% CI 44.0%-47.4%).The final prediction model included age, sex, disease indication, comorbidities and biomarkers at the time of ICD assessment ( Table 1 ). This model had good discrimination in derivation (AUC 0.80; 95% CI 0.78-0.81) and validation samples (0.79, 95% CI 0.77-0.81) and good calibration. Sensitivity analyses showed that the addition of device type, provider factors (implantation site, implanter volume, physician main specialty), sex-related interaction terms, and frailty scores did not significantly improve the prediction model. Conclusion: A combination of demographic and patient factors determined at baseline device evaluation enabled the prediction of 10-year survival in patients undergoing ICD for primary prevention in the clinical practice. Our findings may help identify and monitor individuals at risk of long-term mortality and may be useful in targeting future prevention strategies to enhance longevity in this high-risk population.
Abstract 12011: Troponin Elevation a Marker of Mortality in COVID-19 Patients
Authors: Tatiana Echeverry, Christian von Gizycki, Talha Iqbal, Jamal Anthony, Karlene Williams, Sharen Anghel
Journal: Circulation (2022)

Introduction: Troponin I test has been used as a biomarker for the diagnosis of ACS since 1965. Troponin I has a prognostic value in hospitalized patients with non-cardiac diagnosis. In 2019, The WHO declared COVID-19 as a deadly infectious disease. Given the global impact of this disease, there is a need to identify biomarkers associated with mortality in hospitalized patients. Biomarkers associated with mortality are an important tool for escalation of care in patients deemed at risk of clinical decompensation. The following study demonstrated an association between troponin I elevation and increased mortality among COVID-19 patients. Hypothesis: We sought to determine if Troponin I elevation within 24 hours of admission is associated with increased mortality in COVID-19 patients. Methods: In a retrospective, multicenter study at Atlantic Health System in New Jersey, we analyzed 10,980 first-drawn troponin I values within 24 hours of admission in 34,625 patients between 12/2020-02/2021. Data was analyzed using logistic regression and cox proportional hazard ratio to determine our primary outcome, which is the association of troponin elevation and mortality among COVID-19 patients. Results: The characteristic of 10,980 patients that survived COVID-19 and patients that expired due to COVID-19 during the hospitalization were analyzed. Total of 6,083 were male and 4897 were females. In the survival group, the mean age was 60 with STD 17.2, while in the deceased group the mean age was 74 with STD 13. Logistic regression revealed thatpatients with elevated troponin have increased odds of death compared to others with non-elevated troponin levels (Point estimate 3.301665 ). Females with elevated troponin have greater odds of death than males with elevated troponin ( point estimate 4.484406 in females vs point estimate men 3.301665 ). Patients with elevated troponin have increased hazard by a factor of 1.78 or increased chance of death by 78%. As supporting evidence of our hypothesis patients with an elevated troponin in the first 24 hours have 3.74 increase odds of death. Conclusions: In conclusion, Troponin I elevation within 24 hours of admission is associated with increased mortality in hospitalized COVID-19 patients with 3.7 increase odds of death.
Abstract 12052: Multimarker Approach for Risk Stratification in Patients Undergoing Transcatheter Aortic Valve Implantation
Authors: Sebastien Hecht, Carlos M Giuliani, Jeremy Bernard, Lionel Tastet, Rami Abu-Alhayja'a, Jonathan Beaudoin, Nancy Cote, Robert De Larochelliere, Eric Dumont, Dimitri Kalavrouziotis, Siamak Mohammadi, Kim OConnor, mathieu bernier, Jean-Michel Paradis, Marie-Annick A Clavel, Josep Rodes-Cabau, Philippe Pibarot
Journal: Circulation (2022)

Introduction: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis (AS). However, TAVI may be futile in a substantial proportion of patients. The development of a blood multimarker approach encompassing cardiac damage, inflammation, cancer, and renal function could be useful to accurately identify patients who may benefit from TAVI versus those who may not. Hypothesis: the objective of this study was to examine the association between blood biomarkers and all-cause mortality following TAVI. Methods: Three hundred and sixty-three patients who underwent TAVI at our institution were prospectively recruited. Clinical and echocardiographic data were collected. Nine biomarkers were measured from blood samples collected before TAVI. The cohort was divided in 3 groups according to the number of elevated biomarkers (i.e ≥median of the cohort) per patients. Multivariable survival analysis was performed to evaluate the association between biomarkers and all-cause mortality. The incremental prognostic value of the biomarkers model to predict all-cause mortality was assessed using the net reclassification index (NRI). Results: In comparison with patients with 0-3 elevated biomarkers, those with 4-7 and 8-9 were older, had more comorbidities and higher rate of NYHA ≥III. They also had longer hospital stay following TAVI. During a median follow-up of 2.5 (1.9-3.2) years, 99 (27%) patients died. Using multivariable Cox analysis and patients with 0-3 elevated biomarkers as the referent group, those with 4-7 and 8-9 elevated biomarkers had a higher risk of all-cause mortality (HR [95%CI]: 1.83 [1.01-3.38], p=0.05, and HR [95%CI]: 4.09 [2.16-7.76], p&lt;0.001, respectively). The addition of the number of elevated blood biomarkers provided important incremental prognostic value in comparison with the clinical model (NRI=0.71, p&lt;0.001). Conclusions: An increasing number of elevated biomarkers was associated with higher risk of mortality after adjustment for baseline differences. Moreover, the biomarker model provided important incremental prognostic value beyond the clinical variables and could thus enhance risk stratification of patients undergoing TAVI.
Abstract 12468: Hemodynamic Validation of Echocardiographic Left Ventricular to Left Atrial Volumes Ratio Indices in Heart Failure With Preserved Ejection Fraction
Authors: Przemyslaw Palka, Roland Hilling-Smith, Rohan Swann, Sean Allwood, Alexander Moore, Chris Bian, Aleksandra Lange
Journal: Circulation (2022)

Introduction: The assessment of mean left atrial (LA) pressure rather than Left Ventricular (LV) end-diastolic pressure reflects more accurately filling pressure which is pathophysiological landmark of Heart Failure with preserved Ejection Fraction (HFpEF). Hypothesis: We sought to test whether the measurement of LV to LA volume ratio at the specific cardiac phases can estimate resting LA pressure in patients with HFpEF. Methods: Fifty-three HFpEF patients (mean age 71+-10 years) who underwent cardiac catheterization including direct, at rest, retrograde LA pressure, were analysed. Echocardiographic data was obtained 1.5+-1.0 hours off cardiac catheterization. Patients were divided into: Group 1 (normal filling pressure) and Group 2 (elevated filling pressure, mean LA pressure &gt;12mmHg and/or pulmonary capillary wedge pressure 14mmHg). The ratio of LV/LA volume was measured in end-systole (LV ES /LA max ), end-diastole (LV ED /LA min ), diastasis (LV dias /LA dias ), and as both maximum (LV ED /LA max ), and minimum (LV ES /LA min ). Results: All measured LV/LA ratios were lower in Group 2 as compared to Group 1 and correlated inversely with an increased LA pressure (LV ED /LA min , r=-0.54, p&lt;0.001; LV ES /LA min , r=-0.53, p&lt;0.001; LV ED /LA max , r=-0.52, p&lt;0.001; LV dias /LA dias , r=-0.50, p&lt;0.001; LV ES /LA max , r=-0.37, p=0.013. The following ratios, LV dias /LA dias , LV ED /LA max , LV ED /LA min , and LV ES /LA min , were the most accurate echocardiographic indices to differentiate HFpEF patients between Group 2 and Group 1 (independently off the presence atrial fibrillation), with the area under the curve &gt;0.75 and statistically noninferior to the following a new LA function parameters such as: LA reservoir strain, index LA reservoir strain, LA total emptying fraction and LA active emptying fraction. The cut-off values for LV ES /LA min &lt;1.45 and LV dias /LA dias &lt;1.30 had the sensitivity 78%, 74% and specificity 71%, 71%, respectively, to differentiate patients between Group 2 and Group 1. Conclusions: Among all studied echocardiographic indices the LV ES /LA min and LV dias /LA dias were the most accurate parameters to assess the level of LA pressure in HFpEF.
Abstract 12589: Left Ventricular Unloading Preserves Ventricular Function and Reduces New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Authors: Junya Matsuda, Kakeru Ishihara, Eiichiro Oka, Reiko Shiomura, Junsuke Shibuya, Jun Nakata, Hideki Miyachi, Wataru Shimizu, Takeshi Yamamoto
Journal: Circulation (2022)

Introduction: Left ventricular (LV) unloading by percutaneous ventricular assist device (pVAD) reduces myocardial workload and oxygen consumption and provides a new concept for improving outcome for acute myocardial infarction complicated with cardiogenic shock (AMI-CS). AMI results in reduced LV ejection fraction and left atrium remodeling, and increased the incidence of atrial fibrillation. The aim of this study is to investigate the effectiveness of LV unloading by pVAD in terms of mid-term mortality, LV function, and the incidence of atrial fibrillation. Methods: We retrospectively reviewed AMI-CS patients who were admitted to our hospital between July 2014 and December 2021. We investigated patient demographics and baseline characteristics, mid-term clinical outcome, re-admission rate as well as new-onset atrial fibrillation compared between the patients supported with pVAD and without pVAD group during 180-day follow-up. Results: A total of 82 AMI-CS patients treated with pVAD (n=54) or without pVAD (n=28) were analyzed. Mean age was 70±15 years old and 56 patients were male. Door to balloon time (110±56min vs. 91±53min, p=0.33) and Peak CK-MB (471.8±338mg/dl vs. 486.0±545mg/dl, p=0.43) were similar in both groups. During the 180-days follow-up, 23 patients died and 12 patients were re-hospitalized for heart failure (HF). New-onset atrial fibrillation occurred in 16 patients, which was significantly less frequent in pVAD group (11% vs. 36%. p=0.016). Between baseline and 180-days follow-up period, changes of LV ejection fraction (16% vs. 6%, p=0.02) and NT-proBNP (-28% vs. -5%, p=0.03) were significantly higher in pVAD group. There was no significant difference in 180-day all-cause mortality (28% vs. 29%, p=1.0) between the two groups. Multivariate logistic regression showed new-onset atrial fibrillation was independently associated with an increased risk of HF readmission (hazard ratio 2.63, 95% confidence interval 1.91-3.57; p=0.01). Conclusion: pVAD support preserves LV function following ventricular unloading and reduces new-onset atrial fibrillation, which might be contributed to the improvement of mid-term outcome.
Abstract 11946: Prioritization of Multiomic Rare Variants (RVs) Underlying Electrocardiogram (EKG) Traits Using Bayesian Hierarchical Modeling (“Watershed”)
Authors: Taibo Li, Nicole Ersaro, Benjamin J Strober, Marios Arvanitis, ThuyVy Duong, Jennifer Brody, Henry J Lin, Kent D Taylor, Jerome I Rotter, Stephen S Rich, Nona Sootedehnia, Dan E Arking, Stephen B Montgomery, Alexis Battle
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting &gt;33 million people worldwide. EKG is a powerful tool to diagnose AF. Earlier studies found common and rare genetic variants associated with EKG traits and AF risk. However, each individual genome has thousands of RVs which have not been systematically characterized in EKG traits. Hypothesis Individuals with outlier levels of omic measurements in EKG relevant genes are enriched with functional RVs which contribute to AF risk. Methods We analyzed transcriptomic, methylomic, proteomic, and whole genome sequencing data from 1319 individuals in TOPMed Multi-Ethnic Study of Atherosclerosis. We prioritized RVs with Watershed integrating genomic annotations and omic outlier signals (Fig A). We applied Watershed posterior probabilities as weights for EKG trait association using 30 million RVs in 4559 individuals. We developed a polygenic risk score (PRS) using RV posteriors to assess risk stratification for PR interval. Results The multiomic Watershed model prioritized RVs with large effects as identified by PR interval GWAS ( Fig B ). Each signal contributed to distinct sets of variants. Watershed confirmed known EKG gene associations and implicated splicing outliers in NDUFB8 as a novel association with QT interval. When incorporated in SKAT test, Watershed leveraged 10x more noncoding RVs and replicated associations between PR interval and SCN5A , MYH6 , NEBL , and GORASP1 (missed by the default SKAT model). An RV score synthesized across 494 genes was correlated with PR interval after adjusting for common variant PRS ( Fig C ), suggesting that Watershed-prioritized RVs can complement common variants to improve patient risk stratification. Conclusions Watershed is a promising framework to characterize RVs with functional effects, which informed trait-gene associations and improved patient risk stratification, enhancing mechanistic insights into EKG traits and AF diagnosis.
Abstract 12142: Cardiovascular Associations of Chimeric Antigen Receptor T-cell Therapy: A Retrospective Cohort Study From National Inpatient Sample 2016-2019
Authors: Nischit Baral, Annabelle S Santos Volgman, Arvind Kunadi, Basel Abdelazeem, Hassan Saleh, Soumya Kambalapalli, Krishna P Bashyal, Amith Reddy Seri, Timir K Paul, Niranjan Ojha, prem R parajuli, Joshua D Mitchell
Journal: Circulation (2022)

Introduction: After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies. Hypothesis: There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy. Methods and Results: From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p&lt;0.001) but similar in-hospital mortality (3% vs 4.6%, p=0.334) and similar LOS (21 days vs 20 days, p=0.740). Conclusions: CAR T cell therapy is associated with few cardiovascular conditions. We did not find sex-based differences in in-hospital mortality or LOS in CAR T cell therapy.
Abstract 11937: Genetic Cardiomyopathies Misdiagnosed as Isolated Cardiac Sarcoidosis: High-Yield Results of a Systematic Screening Strategy
Authors: Mallika Lal, Christopher Chen, Luke Masha, Samuel Camacho, Ahmad Masri, Babak Nazer
Journal: Circulation (2022)

Introduction: Isolated cardiac sarcoidosis (ICS) poses a diagnostic challenge due to its patchy myocardial involvement and low yield of endomyocardial biopsy (EMB). The diagnosis is often suggested by (18)F-fluorodeoxyglucose (FDG) avidity on positron emission tomograpy (PET) scan. Genetic cardiomyopathies (some of which may be FDG-avid) often present with similar clinical manifestations as ICS, so we evaluated a systematic screening strategy in which all patients with suspected ICS were offered genetic testing. Methods: We reviewed all patients in our Multi-Disciplinary Sarcoid Consortium for those given a diagnosis of ICS by the referring provider based on FDG-PET scans with myocardial but no systemic FDG avidity. These patients were offered genetic testing with commercially available genetic cardiomyopathy and arrhythmia panels (168 genes). Results: Of 110 patients referred, 16 met inclusion criteria, 1 had EMB-proven ICS, 1 did not consent, and 14 were referred for genetic testing. Ten patients (71%) also underwent cardiac MRI, of which 9 had late gadolinium enhancement. Mean age was 61.7±11.6 years, 12 (86%) were male. Mean ejection fraction at time of presentation was 43±10%. Four patients (29%) had presented with atrio-ventricular block, 12 (86%) with ventricular arrhythmias and 12 (86%) with left ventricular systolic dysfunction. Eight (57%) had EMB without granulomas (6 had not undergone EMB). Of these 14 patients, 5 (36%) had pathogenic mutations: 2 in LMNA, 2 in TPM1, and 1 in MYBPC3 . All 5 patients’ clinical phenotype was consistent with their genotype and 3 had previously been immunosuppressed without clinical improvement or resolution of FDG avidity. Conclusions: Genetic cardiomyopathy is often misdiagnosed as “isolated cardiac sarcoid.” A screening strategy of genetic testing all patients with isolated myocardial FDG avidity on FDG-PET scans had a 36% yield for pathogenic mutations and should be considered as part of routine clinical care.
Abstract 12241: Correlation of Breast and Coronary Artery Calcification and Associated Cardiovascular Risks
Authors: Zachary J Estep, Daniyal Ameen, Josette Hartnett, Rebecca Newman, David H Hsi
Journal: Circulation (2022)

Introduction: There is a known association between microvascular breast artery calcifications (BAC) and atherosclerotic cardiovascular disease. Similarly, coronary artery calcification (CAC) has been shown to have association with 10-year ASCVD risk. Using an investigational artificial intelligence software, we sought to determine if a relationship exists between BAC and CAC severity on CT imaging obtained for non-cardiac reasons and whether this relationship has prognostic implications for major adverse cardiac events (MACE). Methods: A single center retrospective pilot study of patients who underwent CT chest imaging for non-cardiac issues and had also undergone a routine screening mammogram within one year. A database created by our central imaging archives for patients with known CAC and BAC was utilized. CAC severity was scored using the semi-quantitative Weston method. BAC severity (termed Bradley score) was scored by cmAngio R , an automated software created by CureMetrix. Results: Seventy-three patients were included for BAC analysis during a median follow-up of 85 months. A mean Bradley score by cmAngio of 10.40 was significantly associated with low risk of CAC (0-2 Weston). A mean Bradley score for moderate (3-7 Weston) and high (&gt; 7 Weston) risk of CAC was 19.70 and 42.64, respectively. The results were statistically significant (p=0.0222). A CAC total score ≥5 was previously published by us to be the optimal cutoff value for predicting MACEs. Conclusions: This retrospective pilot study confirms a relationship exists between patients found to have BAC as identified by an investigational artificial intelligence software on routine mammogram and CAC on CT imaging obtained for non-cardiac reasons. The addition of routine disclosure of BAC on mammographic reports may be of clinical value to capture patients who may not meet traditional guidelines for coronary atherosclerosis risk stratification and may help primary care clinicians begin discussions about lifestyle modifications and potential treatment directed towards primary prevention of MACE.
Abstract 12646: Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention
Authors: Dan D Nguyen, Kensey Gosch, Rayan El-Zein, Paul S Chan, William L Lombardi, Dimitrios Karmpaliotis, John A Spertus, Cathi M Wyman, William Nicholson, Jeffrey W Moses, J. Aaron Grantham, Adam C Salisbury
Journal: Circulation (2022)

Background: Although CTOs are common in older adults, they are less likely to be offered CTO percutaneous coronary intervention (PCI) for angina relief than younger adults. The health status impact of CTO PCI in adults ≥75 years old has not been studied. We sought to compare technical success rates and angina-related health status outcomes at 12-months between adults ≥75 and &lt;75 years old in the OPEN-CTO registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Registry). Methods: Angina-related health status was assessed with the Seattle Angina Questionnaire (SAQ; score range 0-100, higher scores denote less angina). Technical success rates were compared using hierarchical modified Poisson regression, and 12-month health status was compared using hierarchical multivariable linear regression between adults ≥75 and &lt;75 years old. Results: Of the 1000 patients enrolled, 19.8% were ≥75 years old with a mean age of 79.5 ± 4.1 years. Age ≥75 years was associated with a lower likelihood of technical success (adjusted RR = 0.92, 95% CI 0.86, 0.99, p=0.02) and numerically higher rates of in-hospital major adverse cardiovascular events (9.1% vs 5.9%, p=0.10). There was no difference in SAQ Summary Score at 12-months between adults ≥75 and &lt;75 years old (adjusted difference 0.9, 95% CI -1.4, 3.1, p=0.44) (Figure). Conclusions: Despite modestly lower success rates and higher complication rates, adults ≥75 years old experienced angina-related health status benefits after CTO-PCI that were similar in magnitude to adults &lt;75 years old. CTO PCI should not be withheld based on age alone in otherwise appropriate candidates.